Saturday, June 11, 2011

Andropause? Low Testosterone? At Risk of Developing Diabetes? Get a Free Hormonal Panel and Access Your Personal Health Risks With an Old-Fashioned Measuring Tape.

Image 1: Not as realiable as bloodwork,
but a valid first indicator of testosterone
levels and metabolic health in general
(image from Millionlineincome)
I have been writing about getting hormones tested before. And if you listened to Thursday's episode of Super Human Radio and tuned in even before I was on, you will have heard Dr. Crisler from "All Things Male" talk about the paramount importance of optimal testosterone and free testosterone levels on physiological and pyschological health of the purportedly "stronger" sex (yeah, I am talking about us, guys ;-) If that got you interested or you suspect, for whatever reason, to have low testosterone levels, but are unwilling or unable to spend money on a blood test, you may well be interested in the results of a study that was published in the May issue of the Asian Journal of Andrology (Alan. 2011).

Alan et al. who investigated the relationship of age, adiposity and testosterone levels in 207 otherwise healthy aging men (>= 54 year) with symptoms of hypoandrogenism found a significant correlation of both total and free testosterone levels and the waist-to-height (WHt) ratio of their subjects:
[...] WHt ratio was more strongly correlated with TT and cFT than either WC [waist circumference] or BMI. Furthermore, in models of TT and cFT, the addition of Ht to WC resulted in an increase in the magnitude of the regression coefficients for both WC (inverse correlate) and Ht (positive correlate), with the contributions of both WC and Ht both being significant (P<0.05 for all).
Table 1: Waist-to-height ratio corresponding
to increased risk of high blood pressure,
elevated blood glucose and high triglyceride
levels (data adapted from Leitzmann. 2010)
Or in other words, if your tall and lean chances are your erectile dysfunction or whatever possibly androgen-related problem is plaguing you, is not a result of low testosterone levels. While this does not exclude the possibility that overtly high estrogen levels or low 5a-reductase activity and consequently low DHT levels (I have written about the importance of DHT in the context of "all things male" before) are at the bottom of your problems, you will at least know that checking testosterone alone probably won't provide the answer to your question.

On the other hand, these results exemplify the viscous circle of how low, or as many family physicians like to refer to them, "age appropriate", androgen levels, predispose to (predominantly visceral) adiposity, which - apart from its direct detrimental effects on metabolic health (cf. table 1) - in turn increases aromatization of testosterone to estrogen and thus further reduce the availability of the primary male sex steroid. While it appears that this is another instance of the "chicken and the egg, who was first?"-question, I would argue that chances are that the "age appropriate" decline in androgen levels goes hand in hand with increasing obesity and should thus also be addressed by a multi-faceted approach constituting of professionally* supervised hormone replacement therapy and appropriate life-style changes, in other words, the incorporation of regular exercise and healthy eating habits into your daily routine.

* the attribute "professional" obviously excludes your average family Dr. who considers your testosterone level "age appropriate" and refuses to measure estrogen, DHT, DHEA and all the other endocrine parameters without which you will never get the full picture